Challenges faced by African healthcare workers during the third wave of the pandemic

Abstract Africa experienced the third wave of the coronavirus disease in 2019, which caused an 18% rise in cases in most parts of the continent. As of January 2022, the region had an estimated 10.4 million cumulative cases and more than 233,000 deaths, which add up to the burden on the fragile healthcare system, which continues to face a shortage of staff and resources. In addition, the progression of the pandemic further threatens the supply of healthcare workers in Africa due to the increased risk of infection and death, where more than 10,000 healthcare workers in 40 countries have been infected with the virus. This is amid low vaccination coverage, with only 27% of healthcare workers in Africa being fully vaccinated against the disease. Despite the delayed start and slow progression of the pandemic in Africa, there are increasing concerns over the challenges on the African healthcare workers such as economic insecurity and stressful working conditions, which are associated with limited access to personal protective equipment and other vital resources such as ventilators. In addition, the pandemic further predisposes African healthcare workers to social stigma, burnout, insomnia, depression, and fear of safety in their families. The aim of this study is to highlight the challenges faced by African healthcare workers, provide recommendations for change, and emphasize the need to prioritize their physical and mental well‐being.


| INTRODUCTION
Africa is the second-largest continent, which covers about one-fifth of the total land surface area in the world. The emergence of coronavirus Disease 2019 (COVID-19) caught the world off-guard, creating havoc in different parts of the globe including Africa. Despite the late start and slow progression of COVID-19 in Africa, there are increasing concerns over the impacts of the pandemic on the continent. 1 The emergence of the third wave caused an 18% rise in cases in most parts of the region; this is attributed to the highly transmissible Delta variant, which has been detected in 26 African countries. 2 In addition, the emergence of the Omicron variant has Health Sci. Rep. 2022;5:e893.
wileyonlinelibrary.com/journal/hsr2 also escalated the number of COVID-19 infections, but the number of deaths still remains low in the continent. 3 Many African countries have developed initiatives and policies such as fostering to channel resources toward preventing transmission of the virus as well as creating presidential task forces to guide the pandemic response. 4 Despite the increase in COVID-19 vaccine supplies in Africa through initiatives such as Vaccines Global Access (COVAX), the vaccination rates continue to remain low, with only 10% of the population being fully vaccinated. 4 As of January 2022, Africa received 500 million vaccine doses and administered about 344 million doses, with the majority of the inoculations in Morocco and Egypt. 5 The African public health system has historically struggled to provide optimal healthcare services, with facilities being organized in a pyramidal style, in which the best healthcare services are provided by national hospitals, while the village settings offer a weaker health system. 6

| CHALLENGES TO HCWS
The COVID-19 pandemic has exposed a host of vulnerabilities in the healthcare system of African countries, especially in the wake of the third wave. Disruption of supply chains and inadequate distribution affected access to PPE, isolation beds, and ventilators for HCWs. A pancontinental study found that only 14% of HCWs reported proper access to PPE, 64% reported a lack of isolation wards, and 29% reported no access to ventilators in their work settings. 12 Reports from South Africa stated that most places had inadequate testing and isolation of patients with COVID-19, irrespective of disease severity.
The hospitals were being stretched to their peak capacities such that critical patients were being treated at home and often had no access to oxygen cylinders, a lifesaving commodity. Most of the hospitals were underprepared to deal with the massive surge of critical patients, contributing to the overall increased mortality, thereby creating a severe toll on the HCW's mental health, resulting in feelings of inadequacy, insomnia, anxiety, helplessness, and physical stress. 16,17 This burnout as a result of this pandemic has ultimately led to lesser manpower to deal with the pandemic. This is mainly because of widespread fear and anxiety among HCWs leading to hesitancy and dropping out, along with witnessing the loss of fellow HCWs. 16,18 Social stigmatization and loss of trust in society are other underlooked aspects of the pandemic that take a heavy toll on the HCWs. 17 Compared to the previous two waves, the third wave has brutally incapacitated the healthcare infrastructure. Most areas in Africa have a fragile healthcare infrastructure as represented by very low availability of intensive care unit (ICU) beds such as that seen in Kenya (600 beds for the population of about 53 million) or poor doctor-to-patient ratios (West Africa reported an abysmal two doctors per 10,000 people). 18 It is no wonder that the third wave has tipped over the healthcare system of Africa.
All of this is worsened by the widespread lack of compliance with COVID-19 safety protocols due to a lack of political commitment, misinformation and conspiracy theories, and the inaccessibility of government information in remote areas, especially in regions of sub-Saharan Africa. 18 Hence, there is a need for good coordination between the public and primary care systems.
One of the key challenges faced by African countries is the emergence of new COVID-19 variants, which entails the challenge of detecting and controlling the spread of new variants amidst an upsurge in cases. 18   knowledge-sharing resources. 35